Personalized Heart Monitoring for Breast Cancer Survivors: A Nuanced Approach
As breast cancer survival rates soar, with 4.3 million women in the U.S. currently living with a history of the disease and projections of an additional million in the next decade, heart health emerges as a critical aspect of survivorship care. While certain breast cancer therapies are life-saving, they can also exert stress on the heart, prompting crucial questions about who should undergo closer monitoring.
But is every breast cancer survivor in need of a cardiologist's expertise?
A recent editorial published in JAMA Oncology, led by UCLA Health Jonsson Comprehensive Cancer Center investigators Patricia Ganz, MD, and Eric Yang, MD, presents a nuanced perspective. The authors challenge the notion of blanket cardiac imaging for all survivors, emphasizing the importance of individualized care.
The editorial highlights a study that introduced a novel tool to identify breast cancer survivors at highest risk of heart failure or cardiomyopathy in the decade following treatment. This risk calculator, developed using real-world data from over 26,000 breast cancer patients, revealed surprising insights.
While certain treatments, such as anthracycline chemotherapy and HER2-targeted drugs, do elevate risk, the strongest predictors of serious cardiac disease are unrelated to cancer. Factors like high blood pressure, diabetes, obesity, smoking, and a history of heart disease significantly influence long-term heart health.
The study also found that younger women rarely face elevated risk from cancer treatment alone, suggesting that routine long-term cardiac imaging for all survivors may be unnecessary. Instead, the focus should be on essential preventive measures.
Dr. Ganz and Dr. Yang recommend a tailored approach, considering individual risk factors. Women who received higher-risk chemotherapy, developed heart issues during treatment, are older, have multiple cardiovascular risk factors, or experience symptoms like shortness of breath, fatigue, or swelling may benefit from cardiologist consultations.
The editorial advocates for a shift from universal heart screening to a more targeted approach. It emphasizes the importance of controlling blood pressure, managing cholesterol, maintaining a healthy weight, and recognizing early warning signs of heart disease. For most survivors, regular primary care and oncologist collaboration may be sufficient.
In conclusion, the editorial calls for a personalized approach to heart monitoring for breast cancer survivors, emphasizing the need for tailored care based on individual risk factors and symptoms. This approach ensures that survivors receive the necessary support while avoiding unnecessary interventions.
